N.D. making OK grades in fighting tobacco

January 23, 2012

North Dakota has made the grade in certain aspects of tobacco control, according to a new report from the American Lung Association.

The American Lung Association's State of Tobacco Control 2012 report was recently released, and North Dakota has received marks from across the board. A report card formulated by the group stated that North Dakota received one A, two C's and one F.

The A grade was earned as North Dakota was spending 99 percent of the Center of Disease Control-recommended level on its state tobacco control program, the report card said. The recommendation is for $9.3 million; state and federal funding for North Dakota is a little over $9.2 million.

North Dakota and Alaska were the only two states in the country to receive an A. Wyoming, Hawaii and Delaware earned B grades, for spending 70 to 79 percent of the CDC recommendation. Oklahoma and Maine earned a D grade for spending 50 to 59 percent, and the remainder of the nation spent less than 50 percent, earning them the dreaded F.

In regards to smoke-free air, smoking in most public places is prohibited or restricted. However, the only places that still allow smoking indoors are bars, in which there are no provisions, and tribal casinos or gaming establishments, which are exempt from the otherwise restriction.

While North Dakota fell in the middle, the majority of the states 24, plus the District of Columbia had A's.

North Dakota earned a C grade for helping its tobacco users quit. Methodically, the association looks at Medicaid coverage of tobacco cessation treatments, State Employee Health Plan coverage of tobacco cessation treatments and the investment per smoker each state makes in its Quitline program. Bonus points are available in standards for private insurance, a fourth target area.

In North Dakota, there is a private insurance mandate and the investment per smoker through the Quitline program here, it is $11.86 per smoker exceeds the CDC's recommendation of $10.53 per smoker. State Medicaid and employee health plans cover all seven recommended cessation medications, but in the Medicaid program, there is no coverage on counseling and there are "limits on duration, annual limit on quit attempts for some medications, minimal co-payments required, prior authorization required for all medications and use of counseling to get medications acquired," the report card states. State employee health plans cover individual, group and phone counseling. It also requires prior authorization required for medication and applies dollar limits to medications and counseling.

The majority of the states 32 plus the District of Columbia failed. According to the report, there were no states that received an A grade, and only one Maine received a B.

In North Dakota, the cigarette excise tax earned an F. The methodology of the association's grading for this is based on the idea that the more expensive a pack of cigarettes is, the less people will want to buy.

"Research shows that as the price of cigarettes increases, consumption decreases. For each 10 percent price increase, consumption drops by about 7 percent for youth and 4 percent for adults," the association website said. "The CDC reported that each pack of cigarettes sold in this country costs the economy $10.47 in direct medical costs and lost productivity. So the answer for the cigarette excise tax is simple: The higher the better."

The breakdown of the tax grades states that a tax of $2.92 or up is an A. Gradually, as the tax decreases, so does the grade. An F grade is earned when the tax is under 73 cents; in North Dakota, the tax is 44 cents.

North Dakota is not alone in this failing class, as 14 other states received an F grade the majority of the states. Only five states Washington, New York, Rhode Island, Connecticut and Hawaii have cigarette excise taxes exceeding $2.92. The next highest majority earned C and D grades, meaning their taxes are between 73 cents and $2.18.

North Dakota, in comparison to other states, was on the ball in some cases, such as tobacco prevention and cessation, but fell short in exercising smokefree air laws and imposing a higher cigarette tax.

"North Dakota joins many other states that fell short in its responsibility to enact much-needed laws and policies that save lives and reduce tobacco-related disease," a press release from the American Lung Association of North Dakota, issued Jan. 19 said. "The American Lung Association in North Dakota has long been a leader and strong partner in the work being done to reduce the harm and destruction from tobacco in North Dakota. Our work with partners continues to support policies that prevent youth from starting to smoke, protecting people from exposure to secondhand smoke and help people quit."

While youth and adult smoking rates declined slowly over the past decade, the decline has been inconsistent, according to the North Dakota association chapter. A little less than 18 percent of North Dakotans smoke and, each year, 443,000 people die from tobacco-related illnesses and secondhand smoke exposure.

According to the association's release, tobacco causes an estimated 877 deaths in North Dakota annually and costs the state's economy $442,053,000 in healthcare costs and lost productivity.

"The enormity of the challenge facing us requires combined resources at both the state and federal levels," said Kimberlee Schneider, manager of Advocacy and Tobacco Control with the American Lung Association in North Dakota. "Failure isn't an option, because our end goal is removing tobacco's chokehold on America's health, and that's a life-and-death matter."